Issue: 9
January 2014
HAPPY NEW YEAR!
This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS – not revolution.
In this issue:
+ Clause 118 – Unilateralism Gone Mad
+ Elderly Northern Widows – Not an NHS Budget Priority
+ Beveridge-style NHS – On the Sick List
+ NHS Mental Health – Disappearing Beds
+ The Nirvana of ‘Whole Person Care’
+ Serco in Healthcare – Not a Perfect Role Model
+ Is 24/7 NHS Healthcare Achievable?
+ Legal Drug Addicts
+ Primary Care Commissioning is a ‘Mess’ – says NHS Boss
Clause 118: A Fundamental Attack on Democracy
Behaving like, and sometimes looking like, a petulant schoolboy, Jeremy Hunt MP is apparently furious after a humiliating double defeat by judges who ruled that his attempts to close Lewisham Hospital A&E unit were unlawful.
Mr Hunt now wants to have the law changed so he can get his own way. He is championing Clause 118 in the Care Bill. This clause, if adopted, would grant powers to the Government to close a successful and financially viable NHS hospital if a neighbouring NHS Trust was deemed by Government to be failing. Clause 118 eliminates the need for consultation with patients, the public and even the local CCG.
Clause 118 is a fundamental attack on local democracy and is completely at odds with the Government’s commitment to localism.
The Care Bill was debated in Parliament on Monday 16 December 2013. A 140,000 signature petition to drop Clause 118 was delivered to the Department of Health. Activists rallying outside the DoH’S Richmond House in Whitehall can be seen here: http://www.youtube.com/watch?v=abritFBRs-0
This is the start of the campaign to stop Clause 118 with a final vote in Parliament likely in February 2014.
Beveridge-style NHS Privatisation – History, International Perspective and Bleak Future
Dr Lucy Reynolds in a recent editorial for ‘NHS Managers’ traces the history of state health service privatisation and paints a bleak future for the UK.
John Redwood MP invented the Clinical Commissioning Group device in 1986 as a transitional step to enable the wholesale transformation of our NHS into an insurance-based system.
In Spain, the Beveridge-style NHS has largely been destroyed now as part of the upcoming US-EU trade merger (Transatlantic Trade and Investment Partnership – TTIP) and this has lead to riots over the introduction of charges. The Swedish one has been privatised under competition law, and Sweden’s rural areas now lack medical services. Both Israel and Saudi Arabia had Beveridge-style systems which performed well at low cost, but both are in the midst of privatisation now. It’s only the chaos in Italian politics that has stalled the race to privatisation of health services in Italy under the cloak of European competition law.
In the Cuban Beveridge-style health care system we still have the world’s most competent health service in terms of value for money.
Next year is the target year for signing the TTIP. Probably the most toxic part of the draft TTIP is the ‘investor-state dispute settlement’. This latter mechanism allows big corporations to sue Governments before secret arbitration panels composed of corporate lawyers, which bypass domestic courts and override the will of parliaments. So for example, if the NHS decided in 2018 to outsource the management of the new Ealing Hospital (i.e. the Ealing Urgent Care Centre + ‘Local Hospital’) and UnitedHealth of Minneapolis USA was not invited to bid, UnitedHealth could sue the UK Government. The Green MP Caroline Lucas has published an early-day motion on this ‘investor protection’ issue, but so far only seven MPs have signed up for it.
The EU is attempting to charm us all by predicting the TTIP will create a £1 trillion surge in trade, investment and jobs which will benefit everyone. But the EU just invented that figure and so called ‘free trade’ agreements already in place internationally give the lie to this invention. For example Obama pledged the US-Korea Free Trade Agreement would increase US jobs by 70,000: in fact they dropped by 40,000. Clinton claimed the North America Free Trade Agreement would create 200,000 new jobs but it actually lost 680,000 jobs.
The outsourcing of commissioning support scheduled for 2016 potentially hands control of £65 billion for commissioning NHS secondary and community healthcare to the for-profit sector.
NHS North /South Funding Disparity Penalises The Elderly
David Blunkett MP, writing on the online Guardian web site, points up north/south NHS funding differences. For example the north of England is bracing itself for NHS cuts of £722 million, whilst the Thames Valley can look forward to a growth in NHS allocated funding of £148 million.
This disparity seems somewhat unfair on the elderly, who are generally better off in the south than in the north. There may be more retired people in the south, but many are retired comfortably with income to buy in the kind of help that keeps people active, interested and alive. Many elderly people in the north, already historically disadvantaged, are currently struggling to make ends meet.
The over 85 population in England and Wales reached 1.25 million in 2011 with over 830,000 of them women, of which 620,000 are widows. So it’s the ‘oldest old’ northern widows out of the whole elderly population who are likely to suffer most from the regional disparity of NHS budget cuts.
NHS Mental Health Bed Shortages
‘Health Service Journal’ recently reported that the provision of mental health beds in England had fallen by 31 % over the last 10 years. Over that same period mental health detentions have increased by 6%. Zero psychiatric beds were available in London on two occasions in August 2013. Out of area placements are not uncommon and the use of private provider beds at up to £3,000/week is also not unusual. Long journeys for patients and their loved ones are on the rise. The worst example is that of Manchester Health and Social Care this summer sending 86 patients to a string of private providers some as far away as Harrow – nearly 200 miles distant.
In London, over the last 10 years the number of mental health beds per 100,000 population dropped from 51 to 32 by September 2013.
The NHS mandate states:
‘By March 2015….we expect measurable progress towards achieving true parity of esteem (for mental health), where everyone who needs it has timely access to evidence based services’.
Only 14 months to go for the NHS to meet these expectations…….
The Nirvana of ‘Whole Person Care’
The ‘Toward Whole Person Care’ report from the Institute for Public Policy Research (IPPR) recently tackled this subject. Jackie Ashley’s recent review of this report in ‘The Guardian’ makes for interesting reading.
Anecdotally, it appears, most of us would prefer a health service where we are treated through a single reliable contact. We need to feel more in control and would prefer to stay at home. The seamless knitting together of health care and social care is what we want. Also we’d all like to own our patient records.
However the implications of providing such idealised arrangements are daunting. Providing and maintaining a single point of contact for each of the 45 million adults in England and for each of the 11 million parents and guardians of the children in England is a very big ask.
Healthcare is funded nationally through general taxation, whereas most social care is funded through local authority block contracts and a mix of means-testing and private money.
As for staying at home and making use of home monitoring or tele-monitoring this could become more widespread and save on hospital and GP surgery visits, lengthy journeys and money. But England lags way behind the US and Japan on this.
Owning our own patient records sounds like a great idea. Record sharing and joint care planning offer huge benefits. But not all the historic data is held digitally and the consistent updating of 56 million personal databases sounds like a nightmare project.
Serco Accused of Overcharging and Lying, and Issues a Profit Warning
Serco is one of the country’s leading service outsourcing companies. It claims to employ 5,000 scientists and a forward order book worth £19.1 billion. Serco appears to be good at under bidding for health care contracts, but poor at delivering the contracted service effectively and /or profitably.
+ GP Services, Cornwall
The Government has found that Serco resorted to lying in order to hide the poor quality of its understaffed service. The contract has been terminated 13 months early with Serco stating it will make a £5 million loss on the contract.
+ Managing Braintree Hospital, Essex
Serco was awarded this contract in 2011. It was supposed to run until March 2015, but will now terminate early in December 2014. The hospital apparently failed to attract enough patients and Serco states that it will lose £3 million on the contract.
+ Community Health Service, Suffolk
This contract is currently the subject of a National Audit Office (NAO) inquiry. NAO concerns about the £140 million service include delays in producing care plans for palliative patients and carrying out health assessments for children in care. Serco expects to make a £9 million loss by contract end in October 2015.
+ Abandons Managing GP Practices and Large Hospitals in England
Serco announced in December 2013 that it was pulling out of managing large NHS hospitals and NHS GP surgeries in England. In October 2013 Serco’s healthcare boss resigned and in November 2013 its UK boss quit.
Consistent 24/7 NHS Hospitals by 2016?
Sir Bruce Keogh, NHS Medical Director, trumpeted in December 2013 that he wants NHS hospitals to perform consistently seven days a week, every week. Reports suggest that this is much more about resource utilisation than meeting patients’ needs. Trail blazer NHS Salford Royal Hospital, according to 15 December ‘Sunday Times’, is already offering seven day working and is boasting saving 80 beds and £4.5 million in costs delivering urgent care. However even Keogh admits that seven day working could cost the NHS anything up to an additional £2 billion each year.
On the face of it this will surely generally mean using more dieticians, occupational therapist, speech and language therapists, nurses, healthcare allied professionals, ward clerks and so on it goes. It will also mean needing more beds. If it doesn’t then the NHS secondary care hospital services Monday through Friday must logically be degraded.
Presumably this upgrade in weekend hospital care and treatment will apply to the biggest single cost item in healthcare – mental health. Will the additional mental health staff be available in 2016 to provide 24/7 treatment and care for the mentally ill in NHS hospitals?
All this gush about the ‘inconvenient truth’ that patients fall ill seven day a week makes little sense when seven day, 24 hour GP primary care services are not being simultaneously trumpeted.
Part of the PR splash about this is that it fits in with the goal of fewer but larger and safer hospitals. ‘Safer’ is a tricky one for those whose medical condition will deteriorate or who will die waiting for an ambulance…. travelling in an ambulance….or being parked up in an ambulance queuing outside a rare but large NHS Major Hospital.
Some Privatisation Numbers
+ 10% – of all GP Surgeries in England are run by private companies
+ 358 – the number of GP Surgeries in England run by Virgin Care
+ £20 billion – the value of the NHS budget in England available to private companies over the next few years
+ 105 – the number of companies that have been licensed to provide NHS Community Services
More at www.nhsforsale.info
Deaths from Prescription Antidepressants, Tranquillisers and Painkillers On the Rise
The ONS has reported that 807 people died last year from overdoses of prescription drugs – a rise of 16% in five years. By far the highest proportion of these deaths – 468 in fact – were prescription antidepressant–related deaths.
An estimated 32,000 Britons are thought to be addicted to painkillers such as Solpadeine and MPs think that 1.5 million people are abusing tranquillisers.
Compared with available help for illegal drug addicts there is relatively little help available for legal addicts.
Obsessive Attempts by Jeremy Hunt MP to Micromanage the NHS
Secretaries of State are appointed presumably to be responsible for strategies and policies. Civil servants are paid to implement these strategies and policies.
So why is Hunt himself phoning NHS hospital managers who have failed to meet performance targets? He also keeps banging on about taking money away from clinicians who fail to meet his targets and standards.
Sir Malcolm Grant, Chairman of NHS England with a staff of over 6,000, has publicly berated Hunt and other politicians about continued meddling in the running of the NHS.
Primary Care Commissioning is a ‘Mess’ Admits NHS England Director
‘PULSE’ December 2013 quotes NHS England Medical Director Dr. Mike Berwick saying his organisation is making a ‘mess’ of Primary Care commissioning.
He says NHS England needs closer engagement with GP-led CCGs to sort this out. A recent survey showed that 40% of CCGs believed that NHS England does not share their vision for Primary Care.
With the 152 PCTs having been replaced by 27 ‘Area Teams’ no doubt GPs feel somewhat remote from NHS regional management. To illustrate this the Area Team where I live in Hanwell is called NHS North West London and is the aggregation of eight CCGs across eight Local Authorities. It serves two million people through the services of 1,100 GPs in 400 GP practices.
Berwick is calling for ‘co-commissioning’ of CCGs with Area Teams. What is co-commissioning you might ask? According to the ‘Governance International’ web site:
‘Co-commissioning involves the public sector and citizens working together, using each other’s knowledge and expertise, to prioritise what services should be provided for which people , using public resources and the resources of communities’.
Now I’m all for citizens being involved in the formative stages of requirements definition and plan making for a whole range of public services, but I’m somewhat apprehensive about citizen involvement in prioritising resources for services such as brain surgery, mental health therapy and the removal of limbs and internal organs.
